Perimenopause; Postmenopause

Treatment with hormones may be helpful if you have severe symptoms such as hot flashes, night sweats, mood issues, or vaginal dryness.

Discuss the decision to take hormones thoroughly with your doctor, weighing your risks against any possible benefits. Learn about the many options currently available to you that do not involve taking hormones. Every woman is different. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT).

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE THERAPY

Several major studies have questioned the health benefits and risks of hormone replacement therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

• HT may be started in women who have recently entered menopause.
• HT should not be used in women who started menopause many years ago, except for . An exception is estrogen vaginal creams.
• The medicine should not be used for longer than 5 years.
• Women taking HT should have a baseline low risk for stroke, heart disease, blood clots, or breast cancer.

To reduce the risks of estrogen therapy and still gain the benefits of the treatment, your doctor may recommend:

• Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill)
• Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible
• Having frequent and regular physical exams, including breast exams and mammograms

See also: Hormone therapy for more information about taking hormone therapy.

ALTERNATIVES TO HT

There are some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure. Gabapentin is also effective for reducing hot flashes.

LIFESTYLE CHANGES

The good news is that you can take many steps to reduce your symptoms without taking hormones:

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Menopause

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Review Date: 09/11/2010
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)